L. de Groot

Peri- and intraventricular cerebral sonography in second- and third-trimester high-risk fetuses: a comparison with neonatal ultrasound and relation to neurological development.

To determine whether periventricular leukomalacia (PVL) and peri‐ and intraventricular hemorrhages can be detected in fetuses at risk for preterm birth and to establish the clinical significance of this finding.

Muscle power in "high-risk" preterm infants at 12 and 24 weeks corrected age:a measure for early detection

A group of 72 “high‐risk” preterm infants was studied at the corrected ages of 12 and 24 wk. Only infants with a high risk for developmental deviance with gestational ages below 32 wk and/or birthweights of less than 1500 g were included in the study. In addition, the infants were categorized according to their medical history, as confirmed by the “Neonatal Medical Index” (NMI I to V), with category I describing infants with few medical problems and V characterizing those with the most serious complications. In this study we included only “high‐risk” infants as categorized in NMI III to V, since infants with a “low risk” have been described earlier. Apart from the standard paediatric follow‐up, an age‐adequate neurological assessment was made, with special emphasis on the relationship between active and passive muscle power. When development is optimal, these two components of muscle power should be in balance in order to create a stable posture and fluent motility. We compared muscle power at the corrected ages of 12 and 24 wk to determine whether the method employed to assess muscle power could enhance early detection of deviant development. At 12 wk of age, only 5 infants showed overall optimal muscle power, while at 24 wk this figure had increased to 27. Significantly more infants in NMI III had optimal outcomes at 24 wk of age. When muscle power in the different parts of the body was studied separately at 24 wk, outcomes in shoulders and trunk still showed significant discrepancies in all NMI groups. At this age, fewer asymmetries were found compared to outcomes at 12 wk.

General movements in infants born from mothers with early-onset hypertensive disorders of pregnancy in relation to one year's neurodevelopmental outcome.

BACKGROUND Assessment of general movements (GMs) at three months is considered useful for prediction of adverse neurological outcome in high risk infants. AIMS To study the prevalence of abnormal GMs in infants born from women with early-onset hypertensive disorders of pregnancy and the association of GMs with neurodevelopmental outcome at one year. STUDY DESIGN Prospective study, part of a randomised controlled trial of pre-birth management strategies. SUBJECTS Infants born from women with early-onset hypertensive disorders of pregnancy. OUTCOME MEASURES GMs observation and neurological examination at term and three months corrected age; at one year neurological examination and Bayley Scales of Infant Development. RESULTS From 216 women included, 175 of 178 surviving infants (mean gestational age 31.6 weeks [SD 2.3], mean birth weight 1346 grams [SD 458]), were examined at three months. At term age normal, mildly abnormal and definitely abnormal GMs were observed in 54%, 36% and 10% respectively; and at three months in 47%, 40% and 13%. Mildly or definitely abnormal GMs at three months were not associated with abnormal neurological examination at one year, however, they were associated with delayed psychomotor development at one year (p = 0.01). CONCLUSIONS In this prospective study, including small for gestational age, preterm infants about half of them did not have normal GMs at term and three months. There was no association of GMs at term nor three months with neurological outcome at one year, but there was a significant association of GMs at three months with one year psychomotor development.

Echogenicity changes in the fetal brain, a 6-year follow-up study.

Abstract Objective: To asses the relation between echogenicity changes in the fetal brain and neurodevelopmental outcome until 6 years of age. Methods: Fetuses (n = 124) from pregnancies affected by hypertensive disorders (n = 64) or preterm labor (n = 60) at risk for preterm birth (26–34 weeks gestation) were studied. Moderate echogenicity changes (periventricular grade IB, II; intraventricular grade II–III; local basal ganglia/thalami) in the fetal and neonatal brain were related to neurological outcome and Griffiths mental developmental scales quotients at 1, 2 and 6 years. Multiple regression analysis tested the influence of moderate echogenicity changes and perinatal clinical characteristics on composite outcome (death or abnormal neurodevelopment). Results: Moderate echogenicity changes were present in 37/124 (30%) fetuses. Median gestational age and weight at birth were respectively 31 weeks (range 26–43), 1314 g (range 550–4330), mortality was 19%, follow-up loss 10%. Composite outcome was abnormal in 47/124 (38%). Fetal and neonatal moderate intraventricular echodensities were related to cerebral palsy at 6 years (p < 0.04). In the multiple regression analysis only gestational age was related to composite outcome (p = 0.005). Conclusions: Moderate intraventricular echodensities in the fetal brain related to cerebral palsy at 6 years of age. Gestational age at birth was the main predictor of abnormal composite outcome.

OP32.04: Abnormal fetal general movements are transient in the majority of fetuses at high risk for preterm birth irrespective of the found moderate brain echogenicities

classified according to Swanson’s classification of hand congenital abnormalities. Results: Of the 104 cases, 12 (12%) had an isolated defect of the upper limb, while 92 (88%) showed associated abnormalities involving other organ systems. There were 42 malformations related to failure of differentiation (17 arthrogryposes, 12 clenched hands, 7 camptodactyly, 4 clinodactyly 2 radial deviation of the thumb); 31 cases of malformations due to failure of formation of parts (16 longitudinal and 15 transverse defects), the latter group including ectrodactyly, absent fingers and classic reduction defects. Duplication defects comprised 16 cases (15%) of polydactyly. Generalized skeletal malformations included 5 (5%) cases of sausage-like fingers in the setting of thanatophoric dysplasia. Fetuses with multiple malformations were found to have a very high syndromic risk (77% overall: 30% chromosomal, 47% nonchromosomal), with unfavourable outcome in almost all cases (only 4 survivors, 2 of which with moderate to severe neurodevelopmental delay). On the other hand, the prognosis was usually favourable in case of isolated defects. Noteworthy, the sonographic evidence of the upper limbs anomaly represented the key finding leading to the final diagnosis in 25% of syndromic fetuses. Conclusions: Our study suggests that a thorough prenatal ultrasound characterization of fetal upper extremity anomalies can assist in the differential diagnosis of many chromosomal and non-chromosomal conditions. When isolated, upper extremities malformation tend to have a good outcome.